Opioid Intoxication
DSM-III For more information, see Intoxication Diagnostic Criteria A'''. Recent use of an opioid. '''B. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose). C'''. At least one of the following psychological signs: # euphoria # dysphoria # apathy # psychomotor retardation '''D. At least one of the following neurological signs: # drowsiness # slurred speech # impairment in attention or memory E'''. Maladaptive behavioral effects, e.g., impaired judgment, interference with social or occupational functioning. '''F. Not due to any other physical or mental disorder. Differential Diagnosis Other substances Other Substance-induced Intoxications may cause a similar clinical picture. Barbiturates and alcohol are most likely to be confused in this regard. Barbiturate and Alcohol Intoxication can be distinguished by the absence of pupillary constriction in the latter and by the use of laboratory tests. A mild Hallucinogen Hallucinosis may occasionally cause a similar picture. Cocaine, amphetamines, and hallucinogens cause pupillary dilation; but unless the individual is in a state of severe intoxication, the possibility that this dilation is a sign of Opioid Intoxication is unlikely. DSM-IV For more information, see'' Substance Intoxication'' The essential feature of Opioid Intoxication is the presence of clinically significant maladaptive behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgement, or impaired social or occupational functioning) that develop during, or shortly after, opioid use (Criteria A and B). Intoxication is accompanied by pupillary constriction (unless there has been a severe overdose with consequent anoxia and pupillary dilation) and one or more of the following signs: drowsiness (described as being "on the nod") or even coma, slurred speech, and impairment in attention or memory (Criterion C). Individuals with Opioid Intoxication may demonstrate inattention to the environment, even to the point of ignoring potentially harmful events. The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion D). The magnitude of the behavioral and physiological changes that result from opioid use depends on the dose as well as characteristics of the individual using the substance (e.g., tolerance, rate of absorption, chronicity of use). Symptoms of Opioid Intoxication usually last for several hours, a time frame that is consistent with the half-life of most opioid drugs. Severe intoxication following an opioid overdose can lead to coma, respiratory depression, pupillary dilation, unconsciousness, and even death. Diagnostic Criteria A'''. Recent use of an opioid. '''B. Clinically significant maladaptive behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgement, or impaired social or occupational functioning) that developed during, or shortly after, opioid use. C'''. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs, developing during, or shortly after, opioid use: # drowsiness or coma # slurred speech # impairment in attention or memory '''D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Specify if: * With Perceptual Disturbances Specifier The following specifier may be applied to a diagnosis of Opioid Intoxication: With Perceptual Disturbances This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered. DSM-5 Diagnostic Criteria A'''. Recent use of an opioid. '''B. Clinically significant problematic behavioral or psychological changes (e.g., initial euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, impaired judgement) that developed during, or shortly after, opioid use. C'''. Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and one (or more) of the following signs or symptoms developing during, or shortly after, opioid use: # Drowsiness or coma. # Slurred speech. # Impairment in attention or memory. '''D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. Specify if: * With perceptual disturbances: This specifier may be noted in the rare instance in which hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Differential Diagnosis Other substance intoxication Alcohol intoxication and sedative-hypnotic intoxication can cause a clinical picture that resembles opioid intoxication. A diagnosis of alcohol or sedative-hypnotic intoxication can usually be made based on the absence of pupillary constriction or the lack of a response to a naloxone challenge. In some cases, intoxication may be due both to opioids and to alcohol or other sedatives. In these cases, the naloxone challenge will not reverse all of the sedative effects. Other opioid-related disorders Opioid intoxication is distinguished from the other opioid-induced disorders (e.g., opioid-induced depressive disorder, with onset during intoxication) because the symptoms in the latter disorders predominate in the clinical presentation and meet full criteria for the relevant disorder.